Pain assessment tools are used to determine if a person is experiencing pain that may or may not be related to their primary medical diagnosis. It has been found that the prevalence of pain is two times higher in those over the age of 65 as compared to those younger than 60 (1). Therefore, certain pain assessment tools are more appropriate for the geriatric population. Additionally, certain pain assessment tools can be used to more effectively assess pain in patients with cognitive decline or dementia.
Objectives:
Learn more about pain assessment tool options.
Learn how to accurately administer the pain assessment tools.
Learn how to accurately score the pain assessment tools.
Learn validity/reliability for pain assessment outcomes.
Identify appropriate pain assessment tool for patient population.
Information about PainAssessments:
Verbal Descriptor Scale (VDS) Background/Research: This tool is used for patients that are still articulate and can utilize or understand verbal terms to express the level of pain they are feeling. When compared to four other commonly used scales, the VDS was most sensitive and reliable for the geriatric population (2). Additionally, this scale can be used for patients with mild to moderate cognitive impairment (2). Research has shown that, in general, elderly patients find the VDS easier to use and prefer it to the Visual Analog Scales (3).
Administration: This scale consists of a series of phrases that describe different levels of pain. The patient should be asked to choose the best descriptor of their pain from the following options (1):
Scoring: No pain is given a “0” and most intense pain is given a score of “6”.
When to Use: A therapist can assess the VDS at each visit to track changes in pain overtime in response to treatment or can determine a mean pain number over the course of treatment. Therapists can also utilize reporting of pain location to supplement the findings on the VDS and use different VDS for each area if it would be perceived as beneficial.
Pain Assessment in Advanced Dementia Scale (PAINAD) Background/Research: This tool is a pain behavior tool and should be utilized to assess pain in adults with dementia who cannot communicate adequately enough to describe or rank their pain. (4) When compared to the gold standard method of self-reporting, Numerical Rating Scale (NRS), the PAINAD had a stronger level of concurrent validity and intra-rater agreement. Reliability was found to be 0.90 for all items in patients with and without dementia and 0.94 for those with no cognitive impairments (5). Additionally, this scale is utilized by nursing professionals which allows for more consistent monitoring of patient pain throughout the course of the day (4). Research has found that the agreement between self-reported pain (preferred method) and the PAINAD was moderate. Therefore, the use of the observational PAINAD is helpful in pain assessment when the patient can no longer self-report (6).
Administration: The PAINAD should be administered at admission and with each intervention performed. Observe the patient for 3-5 minutes during activity or during rest. Observe the following areas:
Breathing independent of vocalization
Negative vocalization
Facial expression
Body language
Consolability
Scoring: Each item should be scored independently. Scores range from 0-2 for each item. A score of 0 for an item would insinuate no pain, while scores of 2 would insinuate highest levels of pain. Total score is added for a possibility of a maximum score of 10. Information concerning how to adequately score and observations to help determine the appropriate grade are included in the link below.
When to Use: The PAINAD should be utilized in patients who can no longer self-report their pain due to inability to communicate, namely dementia. It should be utilized at each intervention to monitor patient pain levels and can be used multiple times throughout session with each activity that is being completed.
Pain assessment tools are used to determine if a person is experiencing pain that may or may not be related to their primary medical diagnosis. It has been found that the prevalence of pain is two times higher in those over the age of 65 as compared to those younger than 60 (1). Therefore, certain pain assessment tools are more appropriate for the geriatric population. Additionally, certain pain assessment tools can be used to more effectively assess pain in patients with cognitive decline or dementia.
Objectives:
Information about Pain Assessments:
Verbal Descriptor Scale (VDS)
Background/Research: This tool is used for patients that are still articulate and can utilize or understand verbal terms to express the level of pain they are feeling. When compared to four other commonly used scales, the VDS was most sensitive and reliable for the geriatric population (2). Additionally, this scale can be used for patients with mild to moderate cognitive impairment (2). Research has shown that, in general, elderly patients find the VDS easier to use and prefer it to the Visual Analog Scales (3).
Administration: This scale consists of a series of phrases that describe different levels of pain. The patient should be asked to choose the best descriptor of their pain from the following options (1):
Link to Assessment: http://www.healthcare.uiowa.edu/igec/tools/pain/verbalDescriptor.pdf
Scoring: No pain is given a “0” and most intense pain is given a score of “6”.
When to Use: A therapist can assess the VDS at each visit to track changes in pain overtime in response to treatment or can determine a mean pain number over the course of treatment. Therapists can also utilize reporting of pain location to supplement the findings on the VDS and use different VDS for each area if it would be perceived as beneficial.
Pain Assessment in Advanced Dementia Scale (PAINAD)
Background/Research: This tool is a pain behavior tool and should be utilized to assess pain in adults with dementia who cannot communicate adequately enough to describe or rank their pain. (4) When compared to the gold standard method of self-reporting, Numerical Rating Scale (NRS), the PAINAD had a stronger level of concurrent validity and intra-rater agreement. Reliability was found to be 0.90 for all items in patients with and without dementia and 0.94 for those with no cognitive impairments (5). Additionally, this scale is utilized by nursing professionals which allows for more consistent monitoring of patient pain throughout the course of the day (4). Research has found that the agreement between self-reported pain (preferred method) and the PAINAD was moderate. Therefore, the use of the observational PAINAD is helpful in pain assessment when the patient can no longer self-report (6).
Administration: The PAINAD should be administered at admission and with each intervention performed. Observe the patient for 3-5 minutes during activity or during rest. Observe the following areas:
Scoring: Each item should be scored independently. Scores range from 0-2 for each item. A score of 0 for an item would insinuate no pain, while scores of 2 would insinuate highest levels of pain. Total score is added for a possibility of a maximum score of 10. Information concerning how to adequately score and observations to help determine the appropriate grade are included in the link below.
Link to Assessment: http://geriatrictoolkit.missouri.edu/cog/painad.pdf
When to Use: The PAINAD should be utilized in patients who can no longer self-report their pain due to inability to communicate, namely dementia. It should be utilized at each intervention to monitor patient pain levels and can be used multiple times throughout session with each activity that is being completed.
References: